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Malnutrition Rates Are Alarming in Leer, South Sudan

Carrying her son, 25-year-old Angelina arrives at MSF’s hospital in Leer, a town nestled in the swampy marshlands that surround the White Nile river in Unity State. Her two-year-old son, Gatluok, is sick.

Before his consultation, Gatluok’s measurements are taken. The suspended baby scale shows that he weighs just 5.7 kg. The weight of a healthy boy his age should be 14 kg. Staff measure children’s height, weight and mid-upper arm circumference (MUAC) to assess their level of nutrition.

MSF nutrition nurse Charles Mpona Kalinde tries to comfort him as he, very carefully, carries Gatluok back to his mother after his measurements are taken. The majority of children who come through the ATFC are moderately malnourished. “In these cases,” Ayuelu said, “they are sent home with a week’s supply of a ready-to-use therapeutic food called Plumpy’Nut, a peanut-based paste, and come back every week to be reassessed until they are back to normal health.”

Gatluok is then given the all-important MUAC test. His MUAC measures just 94 mm, well within the red area, indicating that he has severe acute malnutrition. Children like Gatluok who are found to be severely malnourished are admitted into the intensive therapeutic feeding center, where their feeding can be closely monitored and drugs can be prescribed to combat any other complications that can prevent them from recovering from malnutrition.

MSF nurse Peter Bitoang Machar conducts the consultation. Gatluok’s mother tells Peter about their situation at home, how her house was burned, their food stocks were looted, and how they had to flee into the bush.

Within half an hour of arriving, Gatluok is admitted into MSF’s intensive therapeutic feeding center, but it is not an easy solution to the family’s problems. His mother has no food at home and is worried about her other child, who she had to leave behind in the care of her brother.

A week later, Gatluok has recovered from malaria and has started eating again. Hopefully, Gatluok will be discharged within the next few days and will come back for follow up at the feeding center.

July 14, 2014

Before the conflict that erupted in South Sudan in mid-December 2013, Doctors Without Borders/Médecins Sans Frontières (MSF) would typically have around 200 children in its ambulatory therapeutic feeding center (ATFC) at any one time, said Grace Ayuelu, MSF medical team leader in Leer. Ayuelu has been working in Leer hospital for almost a year.

“But now, we have over 1,800 children,” she said. “That is a big number.”

During the conflict, many people’s houses in Leer, as well as the MSF hospital, were looted and razed to the ground. People fled into the bush for safety, many of them going months without anything to eat other than wild roots and whatever else could be gathered from the land.

People are now starting to return to Leer, and the partially destroyed MSF hospital is up and running again, although at half its previous capacity. Now, the busiest area of MSF’s Leer hospital is the ATFC, where children under five are seen and their level of nutrition assessed.

There are over 207 MSF staff from South Sudan and beyond currently working in Leer, providing emergency nutrition and outpatient care to the population. The MSF project in Leer also accounts for two other ambulatory therapeutic feeding centers in southern Unity state, one in Nyal and another in Mayendit.

Before its hospital was destroyed at the end of January, MSF had been working in Leer for the past 25 years, providing both in- and out-patient care for children and adults, surgery, maternity, HIV/TB treatment, and intensive care. The hospital was the only fully functioning secondary facility in all of southern Unity State, serving 270,000 people.